sodium-pertechnetate-tc-99m and Thyroiditis

The differentiation between the various etiologies of thyrotoxicosis, including those with hyperthyroidism (especially Graves' disease [GD], the most common cause of hyperthyroidism) and without hyperthyroidism (like thyroiditis), is an important step in planning specific therapy. Technetium-99m (99mTc) pertechnetate thyroid scanning is the gold standard in differentiating GD from thyroiditis. However, this technique has limited availability, is contraindicated in pregnancy and lactation, and is not helpful in cases with history of recent exposure to excess iodine. The aim of this study was to identify the diagnostic value of the peak systolic velocity of the inferior thyroid artery (PSV-ITA) assessed by color-flow Doppler ultrasound (CFDU) and compare the sensitivity and specificity of this method versus 99mTc pertechnetate thyroid uptake.. We prospectively analyzed 65 patients (46 with GD and 19 with thyroiditis). All patients were evaluated with clinical history and physical examination and underwent 99mTc pertechnetate scanning and measurement of TRAb levels and PSV-ITA values by CFDU. The diagnosis was based on findings from signs and symptoms, physical examination, and 99mTc pertechnetate uptake.. Patients with GD had significantly higher mean PSV-ITA values than those with thyroiditis. At a mean PSV-ITA cutoff value of 30 cm/sec, PSV-ITA discriminated GD from thyroiditis with a sensitivity of 91% and specificity of 89%.. Measurement of PSV-ITA by CFDU is a good diagnostic approach to discriminate between GD and thyroiditis, with sensitivity and specificity values comparable to those of 99mTc pertechnetate thyroid uptake.

Topics: Adult; Blood Flow Velocity; Diagnosis, Differential; Female; Graves Disease; Humans; Male; Middle Aged; Prospective Studies; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroiditis

Possible thyroiditis was suspected in a 56-year-old man who initially presented sore throat because laboratory examinations revealed decreased serum thyroid hormone and the Tc-pertechnetate scintigraphy showed no tracer uptake by the thyroid gland. However, subsequent examination demonstrated that the absence of pertechnetate activity in the thyroid was due to complete replacement of thyroid gland by the metastasis from lung adenocarcinoma, which was unknown at the initial presentation.

Topics: Adenocarcinoma; Adenocarcinoma of Lung; Diagnosis, Differential; Humans; Lung Neoplasms; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroiditis

Thyroid uptake of (99m)Tc-pertechnetate is a useful way to determine the cause of thyrotoxicosis. In daily clinical practice, (99m)Tc-pertechnetate uptake is used to discriminate between Graves' disease and painless thyroiditis when clinical information is not enough to make the distinction. However, since the optimal cutoff value of (99m)Tc-pertechnetate uptake has not yet been elucidated, our aim was to determine this value. We recruited patients with thyrotoxicosis in whom (99m)Tc-pertechnetate uptake was measured in clinical settings between 2009 and 2013. Three experienced endocrinologists (who were blinded to the value of (99m)Tc-pertechnetate uptake and initial treatment) diagnosed the cause of thyrotoxicosis based on thyrotropin, free triiodothyronine, free thyroxine, and thyrotropin receptor antibody levels, and by ultrasound findings and using images of thyroid uptake of (99m)Tc-pertechnetate without the actual values. Ninety-four patients diagnosed as having Graves' disease or painless thyroiditis were finally included. According to the diagnosis, the optimal cutoff value of (99m)Tc-pertechnetate uptake was determined by receiver operating characteristics analysis. A cutoff value of 1.0% provided optimal sensitivity and specificity of 96.6% and 97.1%, respectively. Then, its validity was confirmed in 78 patients with confirmed Graves' disease or painless thyroiditis diagnosed at another institute. Applying this cutoff value to the patients with thyrotoxicosis revealed positive and negative predictive values for Graves' disease of 100% and 88.9%, respectively. In conclusion, a cutoff value for (99m)Tc-pertechnetate uptake of 1.0% was useful to discriminate between Graves' disease and painless thyroiditis.

Topics: Adult; Diagnosis, Differential; Female; Graves Disease; Humans; Male; Middle Aged; Reference Values; Retrospective Studies; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Thyroid Function Tests; Thyroid Gland; Thyroiditis

When thyroid scintigraphy (TS) is performed after contrast-enhanced CT (CE-CT), tracer uptake of 99mTcO4 in the thyroid gland can be inhibited by free iodide. Currently, it is recommended to postpone TS until 4 to 8 weeks after CE-CT, but few data exist to support this recommendation. The purpose was to investigate the effect of CE-CT and other variables for the diagnostic quality of TS.. This retrospective study included 196 patients subjected to TS less than 3 months after a CE-CT (median, 66 days). Patients with elevated thyroid-stimulating hormone (>4.5 mIU/L) or suspected thyroiditis were excluded. Logistic regression was used to calculate the probability of a TS of diagnostic quality with the variables days since CE-CT, age, thyroid-stimulating hormone, and kidney function (eGFR).. Days since CT and age were highly significant (P < 0.001) predictors for diagnostic TS. The probability of diagnostic quality TS after CE-CT increased with time and reached approximately 70% to 80% 6 to 8 weeks after CE-CT. Analysis of age-specific populations showed age to be a strong independent factor.. Our findings are in consensus with the currently recommended interval of 6 to 8 weeks between CE-CT and TS. However, our results indicate that patient age should be taken into account, and we suggest the following delay from CE-CT to TS: 4 weeks for patients aged younger than 50 years, 6 weeks for patients aged 50 to 60 years, and 8 weeks for patients aged older than 60 years.

Topics: Age Factors; Aged; Case-Control Studies; Contrast Media; Female; Humans; Male; Middle Aged; Predictive Value of Tests; Radiopharmaceuticals; Retrospective Studies; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroiditis; Tomography, X-Ray Computed

The differential diagnosis of Graves disease (GD) and silent thyroiditis (ST) is important for the selection of appropriate treatment. To date, no study has compared the diagnostic utility of color Doppler ultrasonography (CDUSG), Tc-99m (technetium-99m) pertechnetate uptake, and thyroid-stimulating hormone (TSH)-receptor antibody (TRAb) for the differential diagnosis of these two conditions. In the present study, we compared the diagnostic utility of inferior thyroid artery (ITA) peak systolic and end diastolic velocities (PSV and EDV) measured by CDUSG, Tc-99m pertechnetate uptake, and TRAb for differential diagnosis of GD and ST.. A total of 150 subjects with GD, 79 with ST, and 71 healthy euthyroid controls were included in the study. Diagnoses of GD and ST were made according to patient signs and symptoms, physical examination findings, the results of TRAb and Tc-99m pertechnetate uptake, and follow-up findings. All subjects underwent CDUSG for the quantitative measurement of ITA blood-flow velocities.. The mean ITA-PSV and EDV in patients with GD were significantly higher than in ST patients. In receiver operating characteristic analysis, the sensitivity/specificity of the 30 and 13.2 cm/s cutoff values of the mean ITA-PSV and EDV for discrimination of GD from ST were 95.3/94.9% and 89.3/88.6%, respectively. The sensitivity/specificity of the 1.0 international unit (IU)/L and 3% cutoff values of the TRAb and Tc-99m pertechnetate uptake analyses were 93.0/91.0% and 90.7/89.9%, respectively.. The measurement of ITA-PSV by CDUSG is a useful diagnostic tool and is a complementary method to the TRAb and Tc-99m pertechnetate uptake methods for differential diagnosis of GD and ST.

Topics: Adult; Autoantibodies; Diagnosis, Differential; Female; Graves Disease; Humans; Male; Middle Aged; Receptors, Thyrotropin; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroiditis; Ultrasonography, Doppler, Color

Painless thyroiditis (PT) is a transient kind of thyrotoxicosis, with lack of uptake on a thyroid scintigraphy in a non-tender thyroid gland, elevated anti-TPO antibodies, no fever, no history of increased iodine intake, and a normal sedimentation rate. The prevalence of PT varies hugely in the literature.. To establish the incidence rate of PT in Denmark as well as to describe the phenotype of PT in more detail.. Tc-99m pertechnetate scintigraphies were performed over a period of 9.75 years on 6022 consecutive patients (2349 had a thyrotoxic episode), and were divided into high or normal (5528), reduced (300) or lack of uptake (194). Patient records were evaluated: 292 with reduced, and 186 with lack of uptake. As a control measure, 230 consecutive thyrotoxic patients were also analyzed.. Based on scintigraphies, 12 patients had PT, 10 with lack of uptake and two with reduced, corresponding to an incidence rate of 0.49/100,000 person years. It was predicted, that only one patient among the newly diagnosed consecutive thyrotoxic cohort had PT. This patient was identified. The prevalence of PT among thyrotoxic patients was 0.51% as evaluated by scintigraphy, and 0.43% among the biochemically thyrotoxic patient cohort. Twenty-five percent had more than one thyrotoxic episode, 75% had at least one subsequent hypothyroid episode, and 33% developed permanent hypothyroidism.. PT presenting with symptomatic thyrotoxicosis is an extremely rare disease in Denmark. Symptomatic PT presents most often with no uptake on a Tc-99m pertechnetate scintigraphy. Clinical follow-up is essential.

Topics: Adolescent; Adult; Aged; Denmark; Female; Humans; Incidence; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroiditis; Thyrotoxicosis

Topics: Adult; Diagnosis, Differential; Female; Humans; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Nodule; Thyroiditis

Interferon-alpha therapy is well known to induce a wide range of thyroid dysfunction. A 22-year-old woman with chronic hepatitis C developed overt hyperthyroidism while on interferon-alpha and ribavirin therapy. Tc-99m thyroid scintigraphy demonstrated virtually absent tracer uptake consistent with subacute thyroiditis. Ten months after starting antiviral therapy, overt hyperthyroidism recurred. Repeat thyroid scintigraphy revealed diffusely increased tracer uptake throughout the thyroid gland consistent with Graves disease. This is an unusual case of 2 forms of hyperthyroidism-confirmed scintigraphically and occurring in the same patient over time while on interferon-alpha therapy.

Topics: Adult; Antiviral Agents; Female; Graves Disease; Hepatitis C, Chronic; Humans; Interferon-alpha; Radionuclide Imaging; Radiopharmaceuticals; Ribavirin; Sodium Pertechnetate Tc 99m; Thyroiditis

The purpose of the study was to assess the role of radionuclide imaging of hyperthyroid patients with no suspicion of nodules. (99)Tc(m) radionuclide scans performed on all 190 patients referred over a 2-year period with symptoms and thyroid function tests compatible with thyrotoxicosis were retrospectively reviewed. 73% of patients were referred by a hospital clinician and 27% were referred direct from the general practitioner. Referral letters and, where applicable, the clinical notes were reviewed and patients with suspected thyroid nodules were excluded. The results of (99)Tc(m) thyroid scans of the 190 patients (age range 23-93 years, mean 48 years) were reviewed. 152 (80%) patients had Graves' disease, 10 (5.3%) had Graves' disease with nodules, 6 (3.2%) had Graves' disease with non-functioning nodules, 5 (2.6%) had viral thyroiditis, 5 (2.6%) had autonomously functioning nodules and 12 (6.3%) were normal studies. Therefore, 20% of patients had a diagnosis other than solely Graves' disease. These diagnoses are important with respect to clinical management. In conclusion, routine radionuclide imaging is worthwhile, as a significant proportion of patients with clinical "Graves' disease" in this study would have received incorrect treatment without the result of this scan.

Topics: Adult; Aged; Aged, 80 and over; False Negative Reactions; Female; Graves Disease; Humans; Hyperthyroidism; Male; Middle Aged; Palpation; Radionuclide Imaging; Radiopharmaceuticals; Referral and Consultation; Retrospective Studies; Sodium Pertechnetate Tc 99m; Thyroid Nodule; Thyroiditis

A 32-year-old woman with a history of Graves' disease had an episode of thyrotoxicosis 2.5 months after her first childbirth. Because of low thyroidal uptake of Tc-99m pertechnetate, a diagnosis of postpartum painless thyroiditis was made and the patient was observed without medication. After the normalization of serum levels of thyroid hormones, a second wave of thyrotoxic symptoms emerged. This time, the Tc-99m uptake was slightly elevated and the patient was diagnosed to have a relapse of Graves' disease. This case underscores the previously reported notion that thyroidal uptake was indispensable to distinguish these two causes of postpartum thyrotoxicosis.

Topics: Adult; Female; Graves Disease; Humans; Pregnancy; Pregnancy Complications; Puerperal Disorders; Radionuclide Imaging; Recurrence; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroiditis; Thyrotoxicosis

Topics: Adenoma; Adult; Aged; Biopsy, Needle; Carcinoma, Papillary; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi; Thyroid Gland; Thyroid Neoplasms; Thyroid Nodule; Thyroiditis

A 64-year-old man presented with clinical unilateral thyroiditis after chronic left neck trauma from his car seat belt. Thyroid function tests were normal. The initial thyroid Tc-99m pertechnetate scan demonstrated decreased uptake in the entire left lobe of the thyroid. The follow-up scan 1 month later showed a more normal uptake in the left lobe. This patient's clinical course, laboratory values, and nuclear medicine scans are compatible with thyroiditis secondary to trauma sustained from his seat belt.

Topics: Humans; Male; Middle Aged; Neck Injuries; Radionuclide Imaging; Seat Belts; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroiditis

Histopathology and scan findings of hot nodule on 99mTcO4- and/or 123I were correlated in 34 patients with thyroid nodules. In a series of 30 hot nodular lesions, 29 were either adenomas or benign nodules; however, one was proved follicular carcinomas histopathologically. And four patients were chronic thyroiditis without nodular lesions in the thyroid lobes, which were diagnosed pathologically and clinically. In 6 patients with palpable thyroid nodules, thyroid scans performed with both 99mTcO4- and 123I were compared. A discrepancy of the two types of scan existed in only one case. Subsequent surgery revealed no malignancy in this patient. From the results of 201T1 imaging of the thyroid gland in 30 patients with cold or hot nodules on either 99mTcO4- or 123I thyroid scanning, we found no distinct difference between the degrees of 201T1 malignant and nonmalignant tumors. It appears that 201T1 accumulation demonstrates only tumor volume and tumor cell viability in these subjects. From these results, it is confirmed that the functional heterogeneities exist in thyroid adenoma tissues as well as in thyroid cancerous tissues. Therefore, the development of the reliable techniques used to distinguish a benign from malignant lesion is indispensable.

Topics: Adenocarcinoma; Adenoma; Adult; Aged; Aged, 80 and over; Female; Goiter, Nodular; Humans; Iodine Radioisotopes; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroid Neoplasms; Thyroiditis

Altogether 54 patients with thyroid nodal lesions (40 of them had thyroid carcinoma) were investigated by 75Se-methionine and a thyrotropic RP. 75Se-methionine turned out to be inappropriate for differential diagnosis of benign and malignant thyroid lesions because of many false-negative results. The combination of positive scanning with 75Se-methionine and 99mTc-pertechnetate (or 131I) raised the diagnostic informative value of the method.

Topics: Diagnosis, Differential; Evaluation Studies as Topic; Female; Goiter; Humans; Iodine Radioisotopes; Male; Neoplasm Recurrence, Local; Radionuclide Imaging; Selenomethionine; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroid Neoplasms; Thyroiditis

Topics: Adenoma; Aged; Female; Humans; Iodine Radioisotopes; Parotid Neoplasms; Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thallium; Thyroiditis

Radionuclide functional dynamic investigation of the thyroid with 99mTc-pertechnetate was performed in 62 patients with diffuse euthyroid and toxic goiter, thyroiditides and in 17 controls. An analysis of the results of investigations and their comparison with clinical findings, an echo- and scintigraphic picture of the thyroid as well as with the levels of total thyroxine, triidothyronine and thyrotropin of the hypophysis showed that the results of a dynamic test of pertechnetate trapping corresponded, to a large extent, to the clinical status of patients with diffuse thyroid changes, correlated with an echographic picture and made it possible to define significant radiodiagnostic signs of thyroiditides. The proposed methods made it possible to increase the volume and improve the quality of diagnostic information in functional investigations of the thyroid status raising the efficacy of diagnosis of thyroid diseases and reducing radiation exposures and the time of investigations.

Topics: Diagnosis, Differential; Goiter; Humans; Radioimmunoassay; Sodium Pertechnetate Tc 99m; Thyroiditis; Thyrotropin; Thyroxine; Triiodothyronine; Ultrasonography

Measurements were made of the activity in samples of breast milk obtained from a patient with postpartum thyroiditis following administration of [123I]sodium iodide and subsequently [99mTc]pertechnetate 24 hr later. Both 123I and 99mTc were found to be excreted exponentially with an effective half-life of 5.8 hr and 2.8 hr, respectively. Less than 10% of the activity was incorporated into breast-milk protein. After administration of [123I]sodium iodide breast feeding should be discontinued for 24-36 hr to reduce the absorbed dose to the child's thyroid.

Topics: Adult; Female; Humans; Iodine Radioisotopes; Milk, Human; Pregnancy; Puerperal Disorders; Radiation Dosage; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroiditis

The paper is concerned with the results of ultrasonic scanning and scintigraphy in various thyroid diseases and neck tumors on the basis of an analysis of the results of the examination of 133 patients and 18 controls. The efficacy of ultrasonic and scintigraphic investigations in some thyroid diseases as well as their comparative informative value in the assessment of anatomotopographic, structural and functional peculiarities of the thyroid were demonstrated. A combined approach to the use of the above methods was substantiated and their priority was indicated.

Topics: Adult; Diagnosis, Differential; Female; Goiter; Humans; Iodine Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Neoplasms; Thyroiditis; Ultrasonography

Topics: Amiodarone; Humans; Hyperthyroidism; Iatrogenic Disease; Iodine; Iodine Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Function Tests; Thyroiditis; Thyroxine

Two elderly adults presented with fever of undetermined origin. Radiogallium imaging showed intense concentration in the thyroid, without abnormal localization elsewhere. In the first case, a repeat radiogallium study performed three weeks later was within normal limits. The patient had 0% uptake of radioiodide, and no demonstrable iodine within the thyroid. This probably represented thyroiditis. In the second case, an elevated T4 (RIA) and borderline elevated T3 resin uptake suggested the "dumping phase" of thyroiditis. The two cases indicate that "benign" diseases of the thyroid can be associated with diffuse radiogallium concentration in the gland.

Topics: Aged; Female; Fever of Unknown Origin; Gallium Radioisotopes; Humans; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroiditis

Thyroid disease is common in developing countries and its management is based on the measurement of thyroid function and the investigation of thyroid masses. This report discusses techniques and outlines a strategy for the measurement of thyroid function using radioimmunoassays of thyroid-related hormones in the blood. It makes proposals for the evaluation of thyroid morphology using echography, pertechnetate imaging and fine needle biopsy. Note is taken of the difficulties facing laboratories in developing countries and the International Atomic Energy Agency is concerned with the practical assessment of these recommendations and of any alternative proposals in this field.

Topics: Biopsy; Developing Countries; Goiter; Humans; Hyperthyroidism; Radioimmunoassay; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Function Tests; Thyroid Gland; Thyroid Hormones; Thyroid Neoplasms; Thyroiditis